2:1 AV Block

Created by team@ekgdx.com on Dec. 27, 2023

Let’s talk about 2:1 AV Block.

Second-degree AV block 2:1, is characterized by the presence of alternating sinus conducted P waves and blocked P waves. It cannot be classified into type I or type II because there is only one PR interval to examine the blocked P wave. A long rhythm strip may help by recording an episode of changing conduction ratio and observing the behavior of the PR interval.

Criteria

  • Every other P wave is nonconducted (blocked).

NOTE: If the conduction improves with atropine or exercise, or worsens with carotid sinus massage, the block is in the AV node.

NOTE: If the conduction worsens with atropine or exercise, or improves with carotid sinus massage, the block is within or below of the bundle of His. 

NOTE: Always look for those hidden P wave that somtimes merges with preceding T wave.

NOTE: If the QRS is narrow and the PR is normal, Mobitz I is likely present. If the QRS is wide and the PR is normal, Mobitz II should be considered (exceptions apply).

 

Graphic explanation 

 

Ventriculophasic sinus arrhythmia in the setting of 2:1 AV block. Note that the PP interval containing the QRS is shorter than the PP interval without the QRS.

 

This is a nice example of 2:1 AV block in the setting of RBBB. What else do you see? More cases available in EKGDX

 

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References

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Thanks for joining us. 

Dr. Roig

2:1 AV Block